9月 | Vesber 最佳RIO论文推荐

卫视博每月从三大权威杂志：Retina、Investigative Ophthalmology & Visual Science、Ophthalmology中各推荐一篇眼科论文。— — 最佳“RIO”论文推荐（9月）Evaluation of the efficacy of posterior scleral contraction in the treatment of macular hole with retinal detachment in high myopia Macular surgery on sclera(Ye J, Wu Y, Zhu S, et al. EVALUATION OF THE EFFICACY OF POSTERIOR SCLERAL CONTRACTION IN THE TREATMENT OF MACULAR HOLE WITH RETINAL DETACHMENT IN HIGH MYOPIA. Retina. 2021;41(9)_1874-1882.）
后巩膜收缩术治疗高度近视黄斑裂孔合并视网膜脱离的手术疗效评价
Purpose
To evaluate efficacy of posterior scleral contraction (PSC) for macular hole withretinal detachment (MHRD) in high myopia.评价后巩膜收缩术（PSC）治疗高度近视黄斑裂孔合并视网膜脱离（MHRD）的疗效。
Methods
Seventy-three MHRD eyes were treated with PSC. A strip was sent across inferiortemporal scleral surface to posterior pole, then two ends were led out from nasal-inferior and temporal-superior areas. It was tightened to contract posterior sclera with designed axial length (AL) shortening ([10% of pre-operative AL-0.5]mm) after aqueous humors drained from anterior chamber. Recovery was classified as type I (retinal reattachment with MH bridged) and II (retinal reattachment without MH bridged). Follow-up duration was 25.3±18.0 months.73只高度近视黄斑裂孔合并视网膜脱离眼接受后巩膜收缩术治疗。将条带穿过颞下巩膜面至后极，然后从鼻下区和颞上区引出两端。前房排出房水后，用设计的轴向长度（AL）缩短法（[10%术前轴向长度-0.5]mm）收紧后巩膜，以收缩后巩膜。恢复类别分为I型（黄斑裂孔桥接的视网膜复位）和II型（无黄斑裂孔桥接的视网膜复位）。随访时间为25.3±18.0个月。
Results
AL was 30.01±2.27mm at pre-operation and shortened by 2.57±0.82mm intraoperatively. At final post-operation, maintained AL shortening was 1.87±0.92mm. Forty-six eyes (63.0%) recovered as type I and 26 eyes (35.6%) as type II, 1 eye (1.4%) unrecovered. Postoperative best-corrected visual acuity (BCVA, logarithm of minimal angle of resolution [LogMAR]) was better than pre-operative one (0.85±0.50 [Snellen 20/125] vs. 1.11±0.56 [Snellen 20/250], P<0.001) with correlation (r=0.662, P<0.001) and consistency (Kappa=0.34, P<0.001) between two. BCVA improvement didn’t differ between recovery types (P=0.206).术前轴向长度为30.01±2.27mm，术中缩短2.57±0.82mm。术后最后一次手术时，维持的轴向长度缩短为1.87±0.92mm。46只眼（63.0%）恢复为I型，26只眼（35.6%）恢复为II型，1只眼（1.4%）未恢复。术后最佳矫正视力（BCVA，最小分辨角对数[LogMAR]）优于术前（0.85±0.50[Snellen 20/125]vs.1.11±0.56[Snellen 20/250]，P<0.001），两者之间具有相关性（r=0.662，P<0.001）和一致性（Kappa=0.34，P<0.001）。恢复类型之间的术后最佳矫正视力改善没有差异（P=0.206）。
Conclusion
MHRD was successfully recovered by PSC with AL shortening. Visual improvement was achieved, correlated and consistent with pre-operative BCVA while independent of recovery types.黄斑裂孔伴视网膜脱离通过后巩膜收缩和轴向长度缩短成功恢复。视力得到改善，与术前最佳矫正视力一致，且与恢复类型无关。
推荐理由
本文研究了高度近视黄斑裂孔伴视网膜脱离患者采用巩膜加压术进行治疗，术后视网膜复位，眼轴缩短，手术治疗效果好。本文创新之处在于对比了术后不同类型的恢复与最佳矫正视力之间的关系，得出恢复类型与视力之间不具相关性。
文章不足之处在于文章病例随访时间显示，手术末次随访的眼轴数据较术中缩短的数据缩短的区间有所降低，对于更远期的随访，比如5年、10年是否依旧能够维持是个未知数，需进一步随访观察。
No.2
Investigative Ophthalmology & Visual Science · 推荐
COVID-19 Home Quarantine Accelerated the Progression of Myopia in Children Aged 7 to 12 Years in China( Ma M, Xiong S, Zhao S, Zheng Z, Sun T, Li C. COVID-19 Home Quarantine Accelerated the Progression of Myopia in Children Aged 7 to 12 Years in China. Invest Ophthalmol Vis Sci. 2021;62(10)_37.）
新冠病毒-19家庭隔离加速了中国7-12岁儿童近视的发展
Purpose
To investigate the effect of home quarantine during the COVID-19 pandemic on myopia progression in children and its associated factors.探讨在COVID-19大流行期间，家庭隔离对儿童近视进展的影响及其相关因素。
Methods
Myopic children aged 7 to 12 years with regular follow-up visits every half a year from April 2019 to May 2020 were included. Cycloplegic refraction was measured at baseline and at two follow-up visits. The first follow-up visit (visit 1) was conducted before the COVID-19 home quarantine, whereas the second (visit 2) was four months after the home quarantine. Myopia progression at visits 1 and 2 were compared. Factors associated with changes in myopia progression were tested with a multiple regression analysis.包括2019年4月至2020年5月每半年定期随访的7至12岁近视儿童。在基线检查和两次随访时测量睫状肌麻痹性屈光。第一次随访（第1次随访）是在COVID-19家庭隔离之前进行的，而第二次随访（第2次随访）是在家庭隔离四个月之后进行的。比较第1次和第2次就诊时的近视进展情况。用多元回归分析测试与近视进展变化相关的因素。
Results
In total, 201 myopic children were enrolled. There was a significantly greater change in spherical equivalent at visit 2 (−0.98 ± 0.52 D) than at visit 1 (−0.39 ± 0.58 D; P < 0.001). Students were reported to have spent more time on digital devices for online learning (P < 0.001) and less time on outdoor activities (P < 0.001) at visit 2 than at visit 1. Children using television and projectors had significantly less myopic shift than those using tablets and mobile phones (P < 0.001). More time spent on digital screens (β = 0.211, P < 0.001), but not less time on outdoor activities (β = −0.106, P = 0.110), was associated with greater myopia progression at visit 2.总共有201名近视儿童入选。在第2次就诊时(−0.98±0.52 D），比第1次随访时(−0.39±0.58天；P<0.001）球面当量的变化显著更大。据报道，与第1次随访相比，第2次随访的学生在用于在线学习的数字设备上花费的时间更多（P<0.001），而在户外活动上花费的时间更少（P<0.001）。与使用平板电脑和手机的儿童相比，使用电视和投影仪的儿童近视转移明显减少（P<0.001）。在第2次随访时发现，控制户外活动的时间不降低（β=−0.106，P=0.110），但是在数字屏幕上花费的时间增加（β=0.211，P<0.001），近视进展同样显著。
Conclusion
Changes in behavior and myopic progression were found during the COVID-19 home quarantine. Myopic progression was associated with digital screen use for online learning, but not time spent on outdoor activities. The projector and television could be better choices for online learning.在COVID-19居家隔离期间发现了行为和近视进展的变化。近视进展与在线学习使用数字屏幕有关，但与户外活动时间无关。投影仪和电视可能是在线学习的更好选择。
推荐理由
本文研究了新冠疫情期间，居家隔离的防控政策对教学方式的改变进一步影响了儿童近视的发展，得出数字屏幕的使用时间与近视的发展想关。文章创新之处在于通过借助社会环境改变的背景设置变量，收集到数字屏幕的使用时长与近视关联，得出针对该环境下更有利于控制近视防控的建议。本文的不足之处在于仅分析了儿童屈光度的进展改变，未收集其他数据改变，例如视力，未来可进一步丰富研究内容。
No.3
Ophthalmology · 推荐
Bidirectional Association between Visual Impairment and Dementia Among Older Adults in the United States Over Time(Chen SP, Azad AD, Pershing S. Bidirectional Association between Visual Impairment and Dementia Among Older Adults in the United States Over Time. Ophthalmology. 2021;128(9)_1276-1283.）
随着时间的推移，美国老年人视力障碍和痴呆症之间的相互影响
Purpose
Although visual impairment (VI) has been associated with worse cognitive performance among older adults, the temporal relationship between the 2 remains subject to debate. Our objective was to investigate the longitudinal impact of VI on cognitive function and vice versa.尽管视力障碍（VI）与老年人的认知能力较差（老年痴呆症）有关，但两者之间的先后影响关系仍存在争议。我们的目的是研究视力障碍与老年痴呆症的相互影响关系。
Design
Retrospective, time-to-event study.回顾性、事件时间研究。
Participants
National Health and Aging Trends Study (NHATS) participants from 2011 to 2018 cycles.参与者为入选2011年至2018年国家健康和老龄化趋势研究（NHAT）的人员。
Methods
A total of 10 676 participants aged 65 years and older were included. Cox proportional hazards regression models evaluated the impact of baseline VI on subsequent dementia and impact of baseline dementia on subsequent VI. Models were adjusted for potential confounding variables, including demographics, clinical comorbidities, and hearing and physical function limitations.共有10676名65岁及以上的参与者被纳入研究。采用考克斯比例风险回归模型，评估初始视力障碍人群继发痴呆的概率以及初始痴呆患者后续继发视力障碍的概率。模型针对潜在的混杂变量进行干扰排除，包括人口统计学、临床共病、听力和身体功能限制。
Main Outcome Measures
Hazard ratio (HR) for incident dementia among participants with baseline selfreported VI and HR for incident VI among participants with baseline dementia.初始视力损害参与者中继发痴呆的比例和初始痴呆参与者中继发视力损害的比例。
Results
Of the 10 676 participants included in the analysis, approximately 40% were aged 65-74 years, 40% were aged 75-84 years, and the remaining 20% were aged 85 years and older. The majority were female (59%), and 68% self-identifified as non-Hispanic White. Among participants with normal cognitive status at baseline, subsequent dementia was observed in 1753 (16%), and among participants with normal self-reported vision at baseline, subsequent VI was reported in 2371 (22%). In adjusted regression models, participants with baseline VI had higher likelihood of developing dementia over subsequent follow-up (HR, 2.3; 95% confifidence interval [CI], 2.0e2.6; P < 0.001). Likewise, participants with baseline dementia had a higher likelihood of developing self-reported VI over time (HR, 2.5; 95% CI, 2.2e2.8; P < 0.001).在纳入分析的10676名参与者中，约40%的人年龄在65-74岁，40%的人年龄在75-84岁，其余20%的人年龄在85岁及以上。大多数是女性（59%），68%的非西班牙裔白人。在初始检查时非老年痴呆症的参与者中，1753人（16%）出现继发性痴呆，在初始检查时视力正常的参与者中，2371人（22%）出现继发性视力障碍。在调整后的回归模型中，初始为视力障碍的参与者在随后的随访中发生痴呆的可能性更高（HR，2.3；95%可信区间[CI]，2.0-2.6；P<0.001）。同样，初始痴呆患者随着时间的推移出现视力障碍的可能性也更高（HR，2.5；95%CI，2.2-2.8；P<0.001）。
Conclusion
Self-reported VI in the US Medicare population is associated with greater dementia likelihood over time, and dementia is similarly associated with greater VI likelihood over time. Associations are likely multifactorial and bidirectional and could be explained by intervening variables in the path from VI to dementia, or vice versa, or by common risk factors for pathological processes in both eyes and brain. These fifindings suggest the need for early identifification of older adults with visual compromise and consideration of visual disability in the cognitively impaired.美国医疗保险人群中视力障碍患者继发老年痴呆有更大的可能性，而痴呆症随着时间的推移继发视力障碍也有更大的可能性。该影响可能是多因素和双向的，可以通过从视力障碍与痴呆的途径中的干预变量来解释，或者通过眼睛和大脑病理过程的共同风险因素来解释。这些发现表明，有必要早期识别患有视力损害的老年人，并重视痴呆患者的视力障碍。
推荐理由
本研究探索了美国老年人视力障碍和痴呆症之间的双向关联,得出两者之间的关系是双向的，相互影响。文章创新点是通过数万人的大样本统计数据进行概率分析，发现视力障碍的参与者继发痴呆的可能性比非视力障碍者更高。痴呆患者继发视力障碍的可能性比非痴呆参与者更高。文章的不足之处为变量因素复杂，尽管在统计学中排除了无关变量，但是对于一些多因素综合影响的结果，无关变量并不是绝对的无关因素，未来须从多个角度，多个方向继续探讨。
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